| NPI | 1710314539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN001641) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 23717) |
| Enumeration Date | 2013-10-11 |
| Last Update Date | 2015-11-02 |